1. Chinese Medicine

The two fundamental systems utilized by traditional Chinese medicine are the theory of Yin and Yang, and secondly, the theory of the Five Elements (or Phases). Both these systems will be considered separately, commencing with Yin and Yang. However, prior to discussing these two systems I will begin by briefly defining some fundamental concepts of traditional Chinese medicine.

Definitions (1, 3, 4, 7, 8)

1. Qi. The term Qi (pronounced "chee"), in traditional Chinese medicine, is best described as vital energy or the inner vitality which determines our ability to resist, and also recover from, various diseases. Qi flows through the body along meridians in the same way that blood circulates in the body. It is possible therefore, not only to have a total body deficiency of Qi, but also localized deficiencies and excesses of Qi may occur if there is an obstruction to the flow of Qi in the body. Since Qi circulates like blood, herbs that improve blood circulation often assist the flow of Qi also.

There are also different types of Qi. "Original" Qi is the Qi which is inherited. It is stored in the 'Kidney (adrenal). Qi also comes from the Lung (oxygen) and the Spleen (digestion of food). There is also "protective" or "defensive" Qi which flows around the lungs and outside the body to protect the body from disease.

  2. Yin and Yang . The terms Yin and Yang refer to the two balancing and opposing qualities of which everything is comprised. Yang is hot, fire, dry, exterior, energy, male, active, daytime, hard, summer, and so on. Yin on the other hand is cold, moist, female, interior, night-time, winter, soft, water, inactivity, and substance or matter. Since Yin and Yang are opposites, harmony can only be achieved by maintaining balance. Within the body, the interior, the blood and other fluids, and the substance of the body, are all Yin. On the other hand, the exterior, the energy, the drive and the heat of the body, are all Yang.

Yin and Yang also occur together. That is, Yin occurs within Yang and vice versa. For instance, a Yin organ within the body will also have its Yang aspects. To illustrate, the storage of blood and the tissue of the heart are Yin, whilst the pumping of blood is Yang. Generally, the tissue and storage function of an organ are Yin, while its secretory role is Yang.

Traditionally, the Kidneys are considered the source of all Yin and Yang. However the Five Elements theory states that "Fire" (Yang) comes from the "Heart".

Disease results if Yang and Yin are unbalanced. For instance, exposure to excessive cold (too much Yin) will result in damage to the Yang. Similarly excessive heat and exertion, fever, infections, and fluid loss will damage the Yin. Excessive or inappropriate use of Yang or Yin herbs (or foods) will also cause an imbalance condition.

Also of interest here is the importance of the Chinese concept of Yin and the physiological explanation of this concept in Western terms. Although some aspects of the body, such as the fluids, the substance of the body, and the parasympathetic nervous system, all of which form separate parts of the Yin, may be readily explainable in Western terms, consideration of Yin as constituting the reserves of the body may not be so clear, especially in a Western context. Yin reserves however, are of vital importance if we are to retain our ability to fully adapt to stressful or emergency situations.

In Western terms, the concept of Yin as representing bodily reserves compares with adrenal reserve capacity which seems to determine our adaptive capacity or the amount of adaptive energy we each possess. While the quantity of these adrenal reserves seems to depend upon adrenal size (i.e. Yin), in traditional Chinese medicine, Kidney (adrenal) Essence is also claimed to be the source of the Yin (and Qi and Yang) of the body. The fact that traditional Chinese medicine claims that the Yang of the body originates from the Kidney ( adrenal ) and also, according to the Five Elements theory, from the Heart (thyroid) , is interesting in view of the Yang nature of adrenalin and thyroxin.

A simple example of Yin deficiency which most of us have experienced at some stage of our lives relates to the consequences of becoming over tired. Who has not wondered why, when we become exhausted from lack of sleep, we suddenly become more energetic. We get a "second wind" even though we are exhausted. This is Yin deficiency due to lack of sleep, which is the fundamental Yin tonic (9), just as exercise is a Yang tonic (9). Even though we seem to have increased energy, it should be noted that this "energy" is ultimately unsustainable due to the fact that it is based upon a depletion of the Yin reserves of the body. It is vital that this distinction between normal energy and the unfocused energy of Yin depletion becomes more readily recognized in the West.

As is so aptly noted by Tierra (9), in the West where there is a general obsession with everything Yang (i.e. energy, drive, aggression, use of stimulants), the concept of Yin deficiency is little understood. The "energy" or Yang which results from Yin deficiency, which incidentally is claimed to be equivalent to excess Vata in the Ayurvedic system (9), tends to be unfocused, scattered and unsustainable (9). Yang must be grounded in Yin. Even though this is patently obvious, since without Yin (substance, fluids, reserves, etc.) there can be no Yang, it is amazing that this point receives little recognition in the West. The prevailing Western mind-set tends to suggest that stimulants will do no harm, no matter how long they are taken.

Stimulants of course, draw upon the reserves of the body (Yin). This is also true of Yang hormones such as adrenalin, cortisol, and thyroxin. Although there is a perception today that stimulants and adaptive hormones have the ability to increase the stamina and energy of the body by "magic", that is, without any physiological cost, nothing could be further from the truth. Even though the healthy person is very adaptable and may tolerate this stimulation or adaptation for considerable periods of time, there is a physiological price to pay. The Yin reserves of the body will eventually become depleted. There is clearly a point beyond optimum health and vitality which involves utilization of bodily reserves. In TCM this is the point where Yang becomes excessive and damages the Yin. Unfortunately, the person who requires stimulation and instant short term gratification is amply provided for by modern society. As is the case with money however, constant withdrawal of reserves may have very serious consequences!! After all, the person with exhausted reserves will hardly be in a position to cope with new demands!!!

When it comes to adaptive hormones such as cortisol we know that it derives its adaptive stamina enhancing effects by mobilizing reserves (Yin) in the body. It is well known for instance, that cortisol draws upon reserves of calcium and phosphate in the bones. Phosphate, being necessary for formation of ATP, is essential for energy production. Cortisol also increases blood sugar levels by mobilizing reserves in the liver or muscles. Thyroxin may also cause a breakdown of bones and a general loss of body tissues as reserves are consumed.

The comparison here between modern science and TCM is indeed enlightening. While science has approached this matter from a reductionist perspective and identified the mechanisms behind these various effects, the holistic approach of TCM on the other hand is much more wide ranging, encompassing the effects upon the entire body. Medical science for instance, is much more likely to see bone loss as an isolated symptom or side effect with no implications for the metabolism of the body as a whole, even in spite of the fact that osteoporosis has been linked to elevation of endogenous cortisol levels (28, 29). Whereas elevated cortisol levels were once utilized by the body to enable us to cope with emergency situations, to save us from the hungry lion for instance, today, in contemptuous disregard of their wide ranging adaptive and Yin mobilizing effects, cortisone type drugs are used by modern medicine to treat the symptoms of all manner of diseases. The central adaptive effects of cortisone may even be described as "side effects."  The expectation that adaptive reserve mobilizing hormones such as cortisol could be used indefinitely to suppress symptoms of chronic diseases without addressing the underlying cause demonstrates a fundamental and most disturbing misunderstanding of the body and its adaptive processes.

The reductionist approach of modern science clearly prevents it from seeing the whole picture. In fact, doctors today are trained NOT to see the " big picture " or the overall balance or harmony of the body. Instead, health is reduced to a series of blood test results.

The Yin Person and the Yang Person (1-4)

According to traditional Chinese medicine everything is comprised of Yin properties and Yang properties. Although the ideal is to attain a balance of both Yin and Yang, most people have either an excess of Yin or an excess of Yang. The differences between a Yang person and a Yin person have been summarized in Table B1.

Table B1. Features of the Yin person and the Yang person

 

The Yin (excess) person

The Yang (excess) person

Character

 Quiet, withdrawn 

Assertive, aggressive

Build

Thin or heavy and flabby

Robust or thin and wiry

Energy

Slow /lethargic

Hyperactive

Posture

Limp or hunched over

Erect/rigid

Voice

Whisper/soft

Strong/loud

Body Odor

Faint 

Strong

Breathing

 Light/shallow

Heavy/loud

Dislikes

Cold

Heat

Mucus

Clear /thin

Colored /thick

Urine Colour

Clear/light colored

Dark

Stool

 Light colored/loose

Dark/hard

Table B2. Five Elements Correspondences ( 1 - 9 )

 

Wood

Fire

Earth

Metal

Water

Yin organ

Liver

Heart

Spleen 

Lungs

Kidney

Yang organ

Gall bladder

Small intestine

Stomach

Large intestine

Bladder

Sense organ

Eyes

Tongue

Mouth

Nose

Ears

Tissue

Tendons

Blood vessels

Flesh/muscle

Skin

Bones

Taste

Sour

Bitter

Sweet

Pungent

Salty

Emotion

Anger

Joy

Meditation

Grief

Fear

Adverse climate

Wind

Heat

Humidity

Dryness

Cold

Indicator

Nails

Complexion

Lips

Breath

Hair

Season

Spring

Summer

Late summer

Autumn

Winter

The Five Elements or Phases (1- 9)
The theory of the Five Elements developed in China independently of the theory of Yin and Yang, although the two systems have now become integrated (3). The theory of the Five Elements teaches that everything is comprised of the "energetic" or "functional" qualities possessed by the five "Elements"; Water, Fire, Earth, Metal and Wood. This is more of a functional or dynamic relationship rather than being strictly chemical or analytical, as is commonly taught in the West.

In essence, each of the Five Elements constitutes part of a cycle which is commonly illustrated by the seasons. Water, for example, corresponds to the season of Winter, and is considered a time of dormancy and replenishing reserves. It is the Yin season and the Yin Element. Water leads to the emergence of new growth and energy in Spring which corresponds to the Wood Element. Wood in turn, creates more energy and leads into the Fire or Yang season (Summer). Of the Five Elements, Fire and Wood are considered Yang, while Water and Metal are considered Yin (3). The Earth Element is a combination of both Yang and Yin (3).

Each Element also corresponds to a certain bodily organ and to various constitutional strengths and weaknesses. Wood, for example, corresponds to the Liver and gall bladder, the eyes, the nails, the tendons, the Spring season and the emotion of anger. Additionally, each Element corresponds to different foods, behaviour patterns and climate. These relationships, termed the Correspondences of the Five Elements, are listed in Table B2.

The Correspondences of the Five Elements, Water ( Kidney ), Fire ( Heart ), Earth ( Spleen ), Metal ( Lung ) and Wood ( Liver ), have considerable diagnostic significance in Chinese medicine because each of the Elements is related to separate external easily visible bodily parts or organs. Since the Liver is related to the nails and the eyes for instance, Wood (Liver) diseases may often be diagnosed by inspecting the eyes and the nails. Additionally, since the Liver is related to the emotion of anger, this also assists in the diagnosis of Wood diseases. It can also be seen from the Correspondences, that the Spleen (Earth) is sensitive to Dampness, the Liver (Wood) to Wind, the Lungs (Metal) to Dryness, the Kidneys (Water) to Cold, and the Heart (Fire) to Heat.

The Correspondences of the Five Elements also assists in the diagnosis of a person's constitution. A Fire person for instance will display features of a disturbance in the Heart (thyroid) system which will be apparent in the tongue, the blood vessels, and the complexion and in the emotion of joy (lacking or excessive). Similarly, a Water person will manifest symptoms of disturbance in the Kidney ( adrenal ) organ system with symptoms relating to the ears, bones, hair, and the emotion of fear (lacking or excessive).

Since each Element (organ) can be more Yin (cold/underactive) or, alternatively, more Yang (hot/overactive), the various Elements also correspond to different manifestations according to whether the organ concerned is overactive or underactive. We may therefore observe either a Wood Yang person or a Wood Yin person.

Additionally, although a person may have inherited a particular constitution, it is possible, through the onset of disease, to acquire the features of a different type of constitution. For instance, if a Wood person were to acquire Kidney (adrenal) disease then the features of a disturbance in the Water Element may become predominant. Although, in such a case, the underlying type of constitution may in fact remain unchanged, the disease state may tend to obscure the features of the original constitution.

In addition to the Correspondences of the Five Elements, there is also a complex interrelationship between the various Elements or organs. Wood (Liver) for instance, stimulates Fire (Heart) while Fire in turn, stimulates Earth (Spleen). This is the "Stimulation Cycle" or "Creation Cycle" of the Five Elements. There is also a "Control Cycle" that delineates the inhibiting interactions of the Elements.

These interrelationships, known as the "Law of Mutual Promotion and Subjugation" of the Five Elements (otherwise known as the "mother-child law" and the "grandparent-grandchild law”), are detailed in Table B3 (1, 3 - 9).

The complex interrelationship between glands (i.e. Elements) described by Chinese medicine, also finds support in modern endocrinology which recognizes the antagonistic and complementary interactions of various endocrine hormones. It is well known for instance, that thyroid hormones (Fire) and adrenal hormones (Water) frequently have opposing or inhibiting effects. Adrenal hormones such as cortisol for instance, may oppose or inhibit the effects of thyroxin. The Chinese express this relationship by stating that Water (Kidney/adrenal) quenches or inhibits Fire (Heart/ thyroid). This stimulation /inhibition action of endocrine hormones is considered a vital part of their regulatory functions.

Table B3. The Law of Mutual Promotion and Subjugation

 

Wood

Fire

Earth

Metal

Water

Stimulates:

Fire

Earth

Metal

Water

Wood

Is stimulated by:

Water

Wood

Fire

Earth

Metal

Inhibits:

Earth

Metal

Water

Wood

Fire

Is inhibited by:

Metal

Water

Wood

Fire

Earth

Before concluding this discussion of Chinese medicine, I briefly list, in Tables B4 and B5, some of the features of the different types of constitutions, according to the theory of the Five Elements.

Table B4. Five Elements Constitutional Types ( 1, 2, 6 - 9 )

 

Wood Person

Fire Person

Character:

Yang



Yin

Angry, impatient, aggressive
workaholic, idealistic

Nervous, moody, timid, indecisive, inhibited, pessimistic

Excited, irritable, talkative, varies between ecstasy & despair

Idealistic, sentimental, hypersensitive, emotional

Mental:

Yang

Yin

Anxious, irritable

Depressed, fearful, insecure

Anxious, excitable

Confused, panicky, timid, introverted

Dislikes:

Yang

Heat

Heat

Health Features:

Yang

 


Yin

Eye disorders, hypertension, sciatica, hyperthyroid, allergies, varicose veins, muscle tension, heart disease Headache, hepatitis, dermatitis, gallstones, neck/shoulder tension, rheumatism, tendonitis

Anxious, hypertension, insomnia, flushed face, hyperthyroid, eczema, sore mouth, lips, tongue, manic depression Hypotension, amnesia, poor circulation, timidity, manic depression,  dizziness

 

Table B5. Five Elements Constitutional Types (1, 2, 6 - 9)

 

Earth Person

Metal Person

Water Person

Character: 

Yang

 

 

Overbearing, meddlesome, blunt, sanguine, optimistic, diplomatic, insensitive

 Self righteous, perfectionist, phlegmatic, dogmatic, even tempered

Blunt, passionate,  confident, fearless, excellent stamina, ambitious, robust,
  authoritarian

 

Yin

Detached, cynical, critical

Melancholic, easily fatigued, conservative, 

Hypersensitive, low resistance, easily chilled,
sentimental, timid,
very poor stamina  

Mental:

Yang

Cheerful, carefree, gregarious

Very stable, thick skinned

Very stable, domineering, passionate

 

Yin

Single minded, worrier, obsessed with details

Depression, sadness

Apprehensive, critical, phobic, inhibited  

Dislikes:

Yang

Heat, humidity

Heat

Heat

 

Yin

 

 

Cold  

Health features:

Yang

 

Diabetes, mania, water retention, excess appetite, mouth ulcers, crave sweets, obesity, gastrointestinal dis.

Hypertension, colic, sinusitis, dry tissues, muscle tension, constipation,  lung diseases

Hypertension, paranoia arteriosclerosis, kidney stones, hyperadrenal
  
  

 

Yin

Diabetes, hypothyroid, bruising, obesity, obsessional syndrome, gastrointestinal disease

Hypothyroid, sinusitis, psoriasis, lack of body hair, lung disease, poor physique

 Hypoadrenal, salt craving,  feelings of coldness, ear/hearing  disorders
 

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